Survey Questionnaires, Examination Components and
Laboratory Components
1999-2000

The Questionnaires and Exam Components can be viewed using Adobe Acrobat reader.

Questionnaires
Questionnaires are administered to NHANES participants both at home and in the trailers. The questionnaires and a brief description of each section follows.

Screener Modules

Screener Module 1 (48KB). This is administered on the doorstep. This set of questions determines if anyone in the household is eligible to be in the sample.

Screener Module 2 (40KB). This establishes the relationship of everyone in the household to everyone else in the household.

Family Questionnaire
Household and family level information is collected here. The sections are labeled to reflect content.
Demographic Background/Occupation 21KB
Food Security 30KB
Health Insurance 32KB
Housing Characteristics 32KB
Income 38KB
Pesticide Use 7KB
Smoking 5KB
Tracking and Tracing 8KB

Sample Person Questionnaire
Individual level information on participants is collected here. The
sections are labeled to reflect content. Please note that the Medical Conditions section covers many subject areas.
Acculturation 7KB
Audiometry 8KB
Balance 8KB
Blood Pressure 14KB
Cardiovascular Disease 5KB
Demographics Information 21KB
Dermatology 9KB
Diabetes 9KB
Dietary Supplements and Prescription Medication 47KB
Diet Behavior and Nutrition 38KB
Digital Symbol Substitution Exercise 9KB
Early Childhood 9KB
Hospital Utilization and Access to Care 9KB
Immunization 4KB
Introduction and Verification 7KB
Kidney Conditions 11KB
Medical Conditions MCQ.010 - MCQ.150 8KB
Medical Conditions MCQ.160 - MCQ.190 8KB
Medical Conditions MCQ.200 - MCQ.290 14KB
Miscellaneous Pain 10KB
Physical Activity and Physical Fitness 28KB
Physical Functioning 17KB
Occupation 23KB
Oral Health 10KB
Osteoporosis 13KB
Respiratory Health and Disease 11KB
Smoking and Tobacco Use 19KB
Social Support 6KB
Tuberculosis 5KB
Vision 8KB
Weight History 15KB

Mental Health Questionnaires

This questionnaire was conducted in the Mobile Examination Center (MEC).

Composite International Diagnostic Interview (188kb) consist of the following:
Generalized Anxiety Disorder Module
Major Depression Module
Interview Panic Disorder Module

MEC ACASI and CAPI Questionnaires
Audio computer assisted personal self interview (ACASI) and  computer assisted personal interview (CAPI) questionnaires are administered in the MEC.  During the visit to the examination center additional questions are administered that cover more sensitive areas such as reproductive health and illegal drug use. The sections are labeled to reflect content.

Audio computer Assisted Personal Self Interview (ACASI) Questionnaire
Alcohol (12-19) 5KB
DISC Predictive Scale - Youth Conduct Disorder (12-19) 6KB
Drugs (12-59) 8KB
Sexual Behavior (14-59) 14KB
Tobacco 19KB

Computer Assisted Personal Interview (CAPI) Questionnaire
Alcohol (20+) 6KB
Current Health Status 5KB
Kidney 5KB
Physical Activity 21KB
Reproductive Health 69KB
Respondent Information 4KB
Tobacco (20+) 19KB

Examination and Laboratory

Dietary Recall 18KB

Measuring Guides for the Dietary Recall Interview

Examination Components (107KB) consist of the following:
Audiometry
Balance and Vistibular Testing
Body Composition
Body Measurements
Cardiovascular Fitness
Dermatology
Lower Extremity Disease
Muscular Strength
Oral Health
Physician's Exam
Vision
Laboratory Components (94KB) consist of the following:
Blood & Urine
Venipuncture
Urine Collection
Bone Markers
Diabetes Profile
Infectious Disease Profile
Markers of Immunization Status
Miscellaneous Laboratory Assays
Kidney Disease Profile
Hormone Profile
Nutritional Biochemistries and Hematologies
Sexually Transmitted Disease Profile
Tobacco Use
Blood lipids
Environmental Health Profile
Special Studies 32KB

This page last reviewed October 15, 2008